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Plasmapheresis for Rapidly Progressive Glomerulonephritis: The Mystique of Dramatic Intervention

Eli A. Friedman, MD
JAMA. 1980;244(21):2446. doi:10.1001/jama.1980.03310210048029.
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Goodpasture's syndrome and its variant, rapidly progressive glomerulonephritis (RPGN), both cause irreversible uremia in weeks to months. These diseases impose great pressure on the responsible clinician to do something more than observe a declining creatinine clearance. From its beginnings, the medical profession has been almost magically attracted to performance of procedures as an alternative to the frustration of watching a patient's condition deteriorate. Neanderthal healers trephined skulls to release evil spirits. Barber-surgeons of the Dark Ages applied cauteries to burn away disease. Renaissance practitioners bled patients into basins or used leeches to extract offending humors thought responsible for illness. As more current examples of vigorous though dubious measures, consider tonsillectomy to retard infections, carotid body extirpation for asthma, and gastric freezing to stop ulcer disease.

From the perspective of contemporary clinical nephrology, treatment of RPGN using plasmapheresis cannot be fairly likened to these "blind" and primitive regimens of our past.


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